The ACOs offered under the ACA were supposed to do this, and some have. We also saw carriers forced to reduce the network sizes in response to the Exchanges implementing formal guidelines on rates and rate increases. Now the carriers are thinking about doing this as a general practice…which is funny, because that is what they were supposed to be doing when they started HMO and PPO plans years ago. By making the lists more “exclusive” they could extract greater discounts. Then the lists expanded and costs continued to climb. So now we go back to the beginning and see what happens…and what complaints will follow. The difference these days is that the discount comes with reduced availability as practices begin to fill. Then what?